Abstract
BackgroundManaging indeterminate-depth burn wounds remains challenging. Laser Doppler Imaging (LDI) has been validated for burn wound depth and can influence the clinical assessment. Our study investigated the value of LDI as an adjunct in determining the need for excision.MethodsSeventy American Burn Association (ABA)-verified burn centers were surveyed. A controlled pre-test assessment without LDI and post-test assessment with LDI of 100 indeterminate-depth burn wounds was conducted to evaluate the influence on the clinical judgment among different health professionals. Relative risk, analysis of variance (ANOVA), paired t-test, and intention-to-treat were used for analysis. A p-value leq 0.05 was considered significant. ResultsAmong 32 burn centers, three confirmed using LDI. Six thousand grader-image interactions were analyzed. There was a significant difference in the predictive accuracy for pre-LDI and post-LDI assessments when all graders were considered (51.9% ± 7.0 vs. 72.9% ± 7.9; p < 0.0001). Post-LDI assessment added 20.9% more accuracy than the pre-LDI assessment. The post-LDI assessment was 1.4 times more likely to correctly predict the need for excision and skin-grafting than the pre-LDI assessment. All groups had an improved performance post-LDI: Group 1 (physicians), 51.9 ± 7.5 versus 76.4±5; Group 2 (nurses), 52.1 ± 6.1 versus 72.7±7.7; and Group 3 (others), 51.7 ± 9.2 versus 68.6 ± 10.1. No statistical difference was observed between groups (p = 0.92). ConclusionLDI makes the clinical examination of indeterminate-depth burn wounds more accurate. For every five LDI evaluations performed, one assessor changed their treatment plan as a result of this imaging technique. LDI is cost-effective and increases the accuracy of determining the severity of indeterminate-depth burn wounds.
Highlights
Accurate visual assessment of burns is an integral step in the treatment plan process for indeterminatedepth burn injuries
There was a significant difference in the predictive accuracy for pre-Laser Doppler Imaging (LDI) and post-LDI assessments when all graders were considered (51.9% ± 7.0 vs. 72.9% ± 7.9; p < 0.0001)
We investigated how additional information from LDI can influence the clinical assessment of indeterminate-depth burn wound digital images
Summary
Accurate visual assessment of burns is an integral step in the treatment plan process for indeterminatedepth burn injuries. With the recent upsurge of telemedicine around the world, many healthcare providers are accepting the use of digital health communications in their medical practices [2]. Digital health communications are becoming especially popular in burn centers because of their improved convenience, accuracy, efficiency, productivity, and clinical decision-making [3]. Verbal or written burn wound descriptions were the sole source of communication between healthcare professionals with limitations of subjectivity, which hindered accuracy. When digital images were introduced, the accuracy of burn assessments improved dramatically [5]. It is more efficient to make an assessment from a digital image than from a provided wound description from other healthcare. Laser Doppler Imaging (LDI) has been validated for burn wound depth and can influence the clinical assessment. Our study investigated the value of LDI as an adjunct in determining the need for excision.
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